HomeMy WebLinkAbout557-zFO~M NO.~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at.N/.S....~attngm..A~i'e ..................................... Street
Map No...xxxx'~ ........... Block No ...... XXX~ ........... Lot No..X,~:J¢ ............ ~.~i.tP,~,....[.s]f., .................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................... ~Ta~.~.y.......],~ ............ , 19..~9.., pursuant to which Building Permit No....Z...~.5.r/. ..............
dated ................ ~em, u~r.y.......1.3 ............. , 195c3...., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ..............
................. ?~.~.~te..e~e..£~l:F..~ell~ .........................................................................................
This certificate is issued to ..... R~,~ol, ld..~gl~.~l¢~ ........~.a~:ff). .......................................................
(owner, lessee or tenant)
of the aforesaid building.
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 551' z
Building Inspector ................. ~' .....
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........ /. .............. 19...~.... ~.
- ', ·
Approved ........................................ 19 ........ Permit No.
Disapproved a/c ..............................................................................................
...... .....................
(Building lnspector)~
Application No.....,>~...~...iZ .............
APPLICATION FOR IIUILDING PERMIT
Da re.......~...'~...~...'~...TT....../....~................... ] ~J~JJ~JJJ
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate t8 the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to.adioining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building inspector will issue o Building Permit to the applicant. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until .a.Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applioable laws, ordinances and regulations.
.... .......... ...................................
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...... ~-. .............................
If applicant is a corporate, signature of duly authorized officer.
(Name and title'of'corporate'officer)
1. Location of land on which proposed work will be done. Map No: ................... ~ ........................ Lot No: ........~...'..'i. ....
Municipality
2. State existing use and occupancy of pr,emise~ and intended use an~.c[,occu~ancy of proposed construction:
a. Existing use and occup y ............. *-....-.-.,~ ......................................................................................................
b. intended use and- Occ;pancy.....' ............~~.~ ........................................................................
3. Nature of work (check wMch applicable): New Building .................... Addition .................... Alteration ....................
Repair ............ .,~.....Removal ......... ~ .......... Demolition .................... Other Work (Describe) ....................
../...(2.
4. Estimated Cost........~...).,...Q...O....O. ................................... Fee ..................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........~ .......... Number of dwelling units on each floor ............................
If garage, number of cars ........... ~ .................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..............................
7. Dimensions of existing structures, Jf any: Front ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ............... ~ ................ ~
8. Dimensions of entire new construction: Front ....... ~Z.....~.i:...~. .... Rear ....... ~.,....~..r....~,.. .... Depth ...~..~..,...~...i.'. ........
Height ............................ Number of Stories ...~...
9. Size of lot: Front ...... ~..~..~ ............. Rear /~ ~r ~ Depth /~ O
10. Date of Purchase ........ ~..~.~.~ ............................ Name of Former Owner .................. ~~..' ..............
1 1. Zono or uso district in which premisos oro situoted ................ '. ....................................................
12. Does proposed construction v~ote,,~ ~,. ~any zoning law, ~?~e or regulation.:) .......... ~ ..................................
Name of Architect .......~~.~ ........................... Address ........................................... Phone NO .....................
N,me o, .......... ..... .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
/Dt
rou
STATE OF NEV~ Y.(~P-~/)/.,. ) S S
COUNTY OF .~..~.......) .'
......................................~J/ ~"-"~.;....~.~ ............. being duly sworn, deposes .and says that he is the applicant
(Name of individual signing applic, gtion) .
above named. He is the..~..../~.~-~ ...................................................................................
(Contractor, agent, corporate officer, etc.)
of saki owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that ali statements contained in this application are true to the best of his knowledge and belief;
and that the work will be performed in the manner ~,fcz6ld~gne;(be application filed therewith,
Sworn to before me this /~ ~'.[~,,~i~:. st~Wo~,~ f//,~/ /1",~ .... ~
~ ~ ~ _ ~. z' ;~;'.~ tn Suffolt~'~ew York ~'~._./>'~ ~' ~ ~ ~ ~
Z ~.. day of ..,K~..~.c~ ,,[,9.e.~/,~.,~/ 52.06.~;,i,}c~ount~ . (S gnature of applicant)
'-- · ~.L~rch 30
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exam in ed.....~.~EV.~..~..../.. ?. .......... 19¢......{..
Approved ..................... '.: ................. 19.~ ...... Permit No..:~.~. ~."~.~.-.Z....
Disapproved o/c ..............................................................................................
..... /..~;,¥.%~.,J.. f.~c;'-..: .' ........ Z.7.~.......(...c,~.~ ~,.~?, ..................... (Building ~nspector)
Application No .... .:~.-:..- .
~ ~ '7' ............
APPLICATION FOR BUILDING PERMIT
Date .......... ~. ............................................. 19 ........ ~....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location.
c. The work covered by this application may not be commenced before issuance of Building Permit·
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant· Such
permit shall be kept on the premises available for inspection throughout the progress of the work·
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificafe of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, ~rchitect, engineer, general contractor, electrician, plumber or builder.
· , ~-....::. :~..~:~ ..::<~...~:~ ........ ~ . ......... .~.~.. ~ ..... ~~ ...................
Name of owner of prem.ses ......
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1 Location of land on whi.ch proposed work will be done. Map No: .................. .e ....................... Lot No: ....................
2. State existing use and occupancy of pr,emises and intended use o~occ~ancy of proposed construction:
............. ................................ ......... % ........................................................
.................. ........................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair ............ ~.~.,..Removal ........ .~, ........ Demolition .................... Qther Work (Describe) ....................
4. Estimated Cost ............ .~' ............................................... Fee ....q .....................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................
If garage, number of cars ~'~ .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..............................
7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ............... ~ ............... ~ , ,,
8. Dimensions of entire new cons?ruction front ............................ Ke ............................ u p n ............................
Height ............................ Number of Stories ~'~
10. Date of Purchase ......... (. ...... .~ .................................... Name of 4For~er Owner ...,~...; .........7.~.'..."~.~.~...~..~ .............
]1. Zone or use district in which premises are situated ....................................................... ]~ .................................
12. Does proposed construction vi~lgte any zoning law, ordin~ce or regulation? ....................................................
s, ..% ......................................... Pho.,
Name of Architect .......................... ~ .............................. Address ...... ¢ .............. rZ......¢ ...... ¢.....Phone NO .....................
Name ............................................................... ~aa ~s ............................................ mane I~ .....................
Locate clearly and distinctl
property lines. Give street and bh
whether interior or corner lot.
PLOT DIAGRAM
all buildings, whether existing or proposed, and indicate all set-back dimensions from
:k numbers or description according to deed, an show street names and indicate
STATE OF NEWz~OJ~.K,f4G. ) q S
COUNTY OF ....... ~,/..: .............. ) //
........................................ ' ....... ; .......... Z.....'..Z;.;L'[;~ ............... be ng duly sworn, deposes and says that ke is the applicant
(Name of individual signing appli~ion) -, ..... ~ '- -~ ......
above named. He Is the ................................................................................................................................. ~ ...............
(Contractor, agent, corporate officer, etc.) ~
of said owner or owners, and is duly authorized to perform or have performed the said work and to make~
this application; that all statements contained in ~.~]~ofion ore true to the best of his knowledge and bel/e~
and that the work wilL be per rmed in the manner-~;~ ~t~e application filed therewith.
Sworn to before me this // ~ ~ r~;fj ?~te o~{~ /' ' ', "' ,'""'"~,- ......
/ ~ da- of ~]' , ~ 19 ?~'2-°~&~:n~°Uet~°~ (Sgnature of app cant) ~